An MSF health worker in protective clothing holds a child suspected of having Ebola in the MSF treatment center in Paynesville, Liberia, October 2014.

MSF’s West Africa Ebola response started in March 2014 and includes activities in Guinea, Liberia, Mali, and Sierra Leone. MSF currently employs 302 international and around 4,000 national locally hired staff in the region. The organization operates eight Ebola case management centers (CMCs), providing approximately 650 beds in isolation, and one transit center. Since the beginning of the outbreak, MSF has admitted more than 8,100 patients, among whom around 4,960 were confirmed as having Ebola. More than 2,300 patients have survived. More than 1,400 tonnes of supplies have been shipped to the affected countries since March.

Facts

Ebola first appeared in 1976 in simultaneous outbreaks in Nzara, Sudan, and in Yambuku, DRC

The latter was in a village situated near the Ebola River, from which the disease takes its name

Fruit bats are considered to be the natural host of the Ebola virus

The case-fatality rate varies from 25 to 90 percent, depending on the strain

If contracted, Ebola is one of the world’s most deadly diseases. It is a highly infectious virus that can kill up to 90 percent of the people who catch it, causing terror among infected communities.

Doctors Without Borders/Médecins Sans Frontières (MSF) has treated hundreds of people with the disease and helped to contain numerous life-threatening epidemics.

Data are based on official information reported by Ministries of Health. These numbers are subject to change due to ongoing reclassification, retrospective investigation, and availability of laboratory results. The figures are underestimated.

MSF Case Numbers

Date of info

Admissions since start of activities*

Confirmed

Recovered

GUINEA

Conakry CMC

02 Jan

1,499

613

303

Guéckédou CMC

05 Jan

1,641

1,081

455

Telimele CMC

Closed

35

21

16

SIERRA LEONE

Bo CMC

04 Jan

476

437

255

Kailahun CMC

03 Jan

1,215

857

466

Magburaka CMC

08 Jan

56

39

12

Freetown CMC

06 Jan

177

81

28

Kissy CMC

08 Jan

5

1

-

LIBERIA

Monrovia (ELWA 3) CMC

29 Dec

1,826

1,225

498

Foya CMC

Closed

695

384

154

Quewein CMC

Closed

17

16

8

TOTAL

7,642

4,755

2,195

* Admissions include all suspected, probable and confirmed cases. Anyone who is admitted is lab tested which can take 1-2 days for results to come back. If they are negative, they are discharged. So the total admissions includes people who are currently waiting for lab confirmation and people who never had Ebola but had symptoms and were therefore admitted to the suspected ward.

MSF Staff on the Ground (as of March 10, 2015)

Guinea: 64 international, approximately 710 national

Liberia: 53 international, around 915 national

Sierra Leone: 108 international, around 935 national

Total: 225 international, around 2,560 national

Since the Ebola outbreak in West Africa was officially declared on March 22, 2014, in Guinea, it has claimed more than 10,000 lives in the region. The outbreak is the largest ever, and is currently affecting three countries in West Africa: Guinea, Liberia, and Sierra Leone. Outbreaks in Mali, Nigeria, and Senegal have been declared over. A separate outbreak in Democratic Republic of Congo (DRC) has also ended.

Following the downward trend of new cases reported in MSF Ebola management centers across the three affected countries during the first weeks of 2015, the number of new cases has seen a slight increase. Surveillance remains weak: the World Health Organization (WHO) reported that during the last week only about 15 percent of new cases in Guinea are from known Ebola contacts. And in Sierra Leone the available data is limited; according to WHO, only 21 percent of new cases were from known contacts. There is almost no information sharing for tracing Ebola contacts between the three most-affected countries. Since a single new case is enough to reignite an outbreak, the level of vigilance should remain high in order not to jeopardize the progress made in stemming the epidemic.

Video of Medical workers use education to combat Ebola outbreak

Sierra Leone

Update: March 23, 2015

The number of cases has been fluctuating in the country, after a sharp decrease in January 2015. On March 15, Sierra Leone recorded the lowest weekly number of cases (55) since June 2014. All of them were reported in north-western districts, as well as in the capital, Freetown.

However, about one-third of new cases still come from unknown contact chains, thus highlighting the need to strengthen surveillance and awareness. MSF is refocusing its activities around outreach activities, surveillance, social mobilization, among others.

Kambia – Cross-border surveillance

At the end of February, MSF ran an evaluation of the needs in the area, which lead to an intervention aiming at reinforcing cross-border surveillance between Kambia district and Forécariah prefecture, in Guinea. MSF is supporting the local Ebola Response Team in contact tracing and surveillance, as well as running active surveillance at the 5 border crossings.

Bo

The last confirmed patient was admitted on January 12, while the last discharge took place on January 26. Decontamination of the wards is underway.

Magburaka

Last patient was discharged on March 13. Outreach activities are ongoing to all chiefdoms in Tonkolili district. Teams are investigating measles cases in the area.

Freetown – Kissy

On January 8, MSF opened an Ebola Treatment Center in Kissy, one of the current hotspots of the epidemic, in the outskirts of Freetown. On January 28, the maternity section of the center (METC) opened, providing obstetric services for Ebola-positive pregnant women. The center is located on the school grounds of Methodist Boys High School. Following the decision of the government to reopen schools, there was an agreement between the Ministry of Health and MSF to move this center to a nearby location. A new site has been identified and the new location is being rehabilitated ahead of the move. Since the facility will still be offering specialized care for pregnant women, the plan is to leave it open until the end of the epidemic.

Freetown – Surveillance and Contact Tracing

MSF is supporting the local Ebola response in nine wards of Freetown, focusing on surveillance, contact tracing, and ensuring that quarantine homes receive appropriate follow up from relevant actors.

Freetown/Prince of Wales Secondary School

The center discharged its last patient on February 23. The team is focusing on outreach activities (disinfection, targeted health promotion, and monitoring of the humanitarian situation in quarantined homes), including monitoring suspected measles cases in western Urban area. MSF is also running a survivor clinic, providing medical follow-up to an average of 20 survivors per day. MSF is also working with local authorities for the integration of survivor’s health needs into the existing health system.

Liberia

Update: March 23, 2015

On Friday March 20, a patient tested positive for Ebola in the transit center run by MSF in Liberia's Ministry of Health Redemption Hospital in Monrovia. This is the first confirmed Ebola case in Liberia since the last patient was discharged March 5.

In the past weeks, MSF has progressively reduced its Ebola related activities, and is working today in Monrovia in two facilities: the Redemption Hospital transit center and ELWA 3.

Support of non-Ebola healthcare remains a priority.

Monrovia: ELWA 3 ETC

The Ebola patient who was diagnosed on March 20 is currently being taken care of in this ETC, which had been previously empty. MSF is currently redefining its presence in the center, whose capacity has been reduced to 30 beds.

Monrovia: Addressing Non-Ebola Needs

Since February 2015, MSF also runs a survivor clinic, to provide care to patients who recovered from Ebola. In addition to care for reported aftereffects of the disease, the clinic also offers access to primary healthcare for these patients, who often face stigma and fear when seeking care in non-Ebola healthcare structures.

MSF is also supporting 23 Health facilities in the city, and their staff trained on Infections Prevention and Control. A team is also supporting the pediatric and maternal James Davis Junior Memorial (JDJ Hospital) in Monrovia.

Finally, more than 180 cases of measles were reported in Monrovia in the last weeks. MSF is supporting health facilities for case management, and is currently planning vaccination activities in collaboration with the ministry of Health and its partners.

Monrovia: Redemption ETU, health promotion and training

In Redemption Hospital, MSF has been running an Ebola Transit Unit, providing training on infection prevention and control, as well as outreach activities in the surrounding health centers and the communities. MSF is currently re-evaluating its presence in the hospital, whose Emergency Unit reopened in March.

Training of Healthcare Staff

Since March 18, MSF is running three-day RITE (Rapid Isolation and Treatment of Ebola) trainings for County Health Teams staff in four counties (Grand Cape Mount, Bomi, Nimba and Montserrado).

Guinea

Update: March 23, 2015

While there are virtually no more cases in the south-eastern part of the country, cases are still reported in five prefectures in the west as well as in the capital, Conakry. In mid-March, the country registered the highest number of weekly cases since the beginning of the year (95), showing that the epidemic is not yet under control. The number of unreported community death and unsafe burials remains concerning.

Conakry

Between March 9 and 15, 23 new cases were admitted in Donka ETC, which is an increase with regard to the 10 cases admitted in the previous week. The teams are strengthening their efforts in health promotion in the city, while continuing outreach and training activities. MSF is also setting-up a new ETC in Nongo, Conakry, whose opening is scheduled end of April.

On March 7, the trial of VSV-EBOV, one of the two experimental vaccines against Ebola, officially started in Conakry. The vaccine will be administered on a voluntary basis to both frontline Ebola workers and people having being in contact with Ebola patients, selected according to strict criteria, in order to evaluate its safety and efficacy. MSF is participating to the trial.

Guéckédou

In the CTE that MSF runs in Guéckédou, there have been no admissions since January. No cases were declared in the prefecture for more than 80 days, and MSF is considering changing the setup in the area to cover a wider part of the region.

Rapid Response Teams – Faranah

MSF deployed its rapid response team in this area, where 50 percent of the new cases of the country were declared week up to March 15. After an evaluation phase, the team will focus on coordination of the response in two districts near the border with Sierra Leone.

Kankan

In the town of Kankan, MSF set up an ETC and ran outreach activities in the surrounding area. No cases have been declared in the area since December 2014. Cases of meningitis and measles have been declared in the area in mid-March.

Nigeria

Update: October 23, 2014

WHO declared October 20 as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed.

Senegal

Update: October 23, 2014

WHO declared October 17 as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed. MSF’s West African Unit (Dakar) will keep in contact with the government for follow-up as part of their routine activities.

Democratic Republic of Congo (DRC)

Update: November 20, 2014

The outbreak in DRC’s Equateur province, which was unrelated to the one in West Africa, was declared over this week. Around 60 MSF staff worked on this outbreak and two case management centers were established. The MSF teams have activated an exit plan.

Uganda

Update: November 20, 2014

On September 29, a case of Marburg fever was declared in Uganda. MSF has helped reinforce local capacities for treating confirmed cases and for infection control. No new cases of the disease have been declared since.

Mali

Update: November 20, 2014

Mali confirmed its first case of Ebola on October 23. So far there have been seven reported deaths in the country (including the first case): five confirmed with Ebola and two suspected cases. To date, 360 contacts have been identified and nearly all have been placed under surveillance.

In Bamako, MSF is running a CMC in collaboration with CNAM, Mali’s national disease center. The only confirmed Ebola patient admitted to this facility recently died. The case was detected on November 11 and the patient was immediately admitted to the facility. There is one more suspected case currently at the CMC.

MSF has reinforced its team and expanded its activities to help stop the disease spreading further. MSF is training Malian staff from CNAM to manage Ebola cases, and is overseeing the organization of an ambulance system and safe burials.

No specific treatment or vaccine is yet available for Ebola.

Symptoms of Ebola

Early on, symptoms are nonspecific, making it difficult to diagnose.

The disease is often characterised by the sudden onset of fever, feeling weak, muscle pain, headaches, and a sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and, in some cases, internal and external bleeding.

Symptoms can appear from two to 21 days after exposure. Some patients may go on to experience rashes, red eyes, hiccups, chest pains, difficulty breathing, and swallowing.

Diagnosing Ebola

Diagnosing Ebola is difficult because the early symptoms, such as red eyes and rashes, are common.

Ebola infections can only be diagnosed definitively in the laboratory by five different tests.

Such tests are an extreme biohazard risk and should be conducted under maximum biological containment conditions. A number of human-to-human transmissions have occurred due to a lack of protective clothing.

“Health workers are particularly susceptible to catching it so, along with treating patients, one of our main priorities is training health staff to reduce the risk of them catching the disease while caring for patients,” said Henry Gray, MSF’s emergency coordinator, during an outbreak of Ebola in Uganda in 2012.

“We have to put in place extremely rigorous safety procedures to ensure that no health workers are exposed to the virus—through contaminated material from patients or medical waste infected with Ebola.”

Treating Ebola

MSF

No specific treatment or vaccine is yet available for Ebola.

Standard treatment for Ebola is limited to supportive therapy. This consists of hydrating the patient, maintaining their oxygen status and blood pressure, and treating him or her for any complicating infections.

Despite the difficulty of diagnosing Ebola in its early stages, those who display its symptoms should be isolated and public health professionals notified. Supportive therapy can continue with proper protective clothing until samples from the patient are tested to confirm infection.

MSF contained an outbreak of Ebola in Uganda in 2012 by placing a control area around the treatment center.

An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.

Risk of Ebola Spreading

The risk of Ebola spreading to the US is minimal, but to minimize it even further we need more resources to bring the outbreak under control in West Africa.

Before this outbreak, MSF has treated hundreds of people affected by Ebola in Uganda, Republic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon, and Guinea. In 2007, MSF entirely contained an epidemic of Ebola in Uganda.

"I was collecting blood samples from patients. We did not have enough protective equipment to use [and] I developed the same symptoms,” says Kiiza Isaac, a nurse from Uganda.

On November 19, 2007, I received laboratory confirmation—I had contracted Ebola.

"MSF came to Bundibugyo and they ran a treatment center. Many patients were cared for. Thank God, I survived. After my recovery, I joined MSF."

It is estimated there have been over 1,800 cases of Ebola, with nearly 1,300 deaths.

The Ebola virus was first associated with an outbreak of 318 cases of a hemorrhagic disease in Zaire (now the Democratic Republic of Congo) in 1976. Of the 318 cases, 280 died—and died quickly. That same year, 284 people in Sudan also became infected with the virus, killing 156.

The Ebola virus is made up of five species: Bundibugyo, Ivory Coast, Reston, Sudan, and Zaire, named after their places of origin. Four of these five have caused disease in humans. While the Reston virus can infect humans, no illnesses or deaths have been reported.

MSF has treated hundreds of people affected by Ebola in Uganda, Republic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon and Guinea. In 2007, MSF entirely contained an epidemic of Ebola in Uganda.